The Care Quality Commission
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  • GP practice

Archived: Rishton and Great Harwood Surgery Also known as Dr's P and H Valluri

Overall: Good read more about inspection ratings

High Street Medical Centre, 32 High Street, Rishton, Blackburn, Lancashire, BB1 4LA (01254) 884226

Provided and run by:
Rishton and Great Harwood Surgery

Important: The provider of this service changed. See new profile

All Inspections

20 December 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rishton and Great Harwood Surgery on 23 May 2017. The overall rating for the practice was good, with the key question of well led rated as requires improvement. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for Rishton and Great Harwood Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 23 May 2017. This report covers our findings in relation to those requirements.

Overall the practice is now rated as good, with the previous rating of requires improvement for the key question of well led updated to a rating of good.

Our key findings were as follows:

  • The practice was able to demonstrate that policy and procedure documents had now been updated to be practice specific and contained up to date information.

  • Risk management had improved. Appropriate risk assessment documentation had been produced and mitigating actions put in place to minimise risks associated with recruitment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

23 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rishton and Great Harwood Surgery on 7 September 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months, with conditions imposed on the provider’s registration. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Rishton and Great Harwood Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 23 May 2017. Overall the practice is now rated as Good.

Our key findings were as follows:

  • There were improved systems around recognising, recording and learning from significant events.

  • The practice had improved and embedded its systems to minimise risks to patient safety, although some further improvements around the documentation of recognised risks and thorough completion of mitigating actions was still required in some cases.

  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. We saw that there was improved managerial oversight of staff training.

  • Patients were consistently and strongly positive about access to appointments at the practice.

  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

  • Communication channels in the practice, both internally between clinicians and non-clinical staff, and externally with other health and social care providers had improved.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

In addition, the practice should:

  • Ensure consultation notes written into patient records contain sufficient detail to accurately record what took place during the appointment.

  • Implement actions to encourage the uptake of breast cancer screening.

I am taking this service out of special measures and removing the conditions we had previously imposed on the provider’s registration. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

07/09/2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Rishton and Great Harwood Surgery was inspected in September 2015. This inspection resulted in an overall rating of Requires Improvement, with an inadequate rating for the Safe domain. A Warning Notice was served against the provider on 26 October 2015. The provider was failing to meet the required standards relating to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe Care and Treatment. In June 2016 we carried out a focussed inspection of the Rishton site to check the provider had taken the required action in relation to the Warning Notice, where we found not all the required action had been taken in relation to risk management and recruitment of staff.

We carried out an announced comprehensive inspection on 7 September 2016 in order to fully re-inspect and assess what progress had been made.

During this inspection we found that insufficient improvements had been made.

Overall the practice is now rated as inadequate.

Our key findings across all the areas we inspected were as follows:

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate systems were not in place to monitor patients being prescribed with high risk medication.

  • We found that appropriate action was not being taken to safeguard vulnerable children.

  • The practice lacked a clear system for reporting incidents, near misses and concerns and there was limited evidence of learning and communication with staff.

  • Staff did not have access to appropriate training. The practice had not implemented a system of appraisals in order to assess training needs.

  • There was limited awareness of the need to protect confidential information within the practice.

  • The practice lacked leadership and had limited formal governance arrangements.

  • We received mixed feedback from patients about the manner in which clinical care was delivered by the GP

  • Clinical audits demonstrated quality improvement.

  • Patients were positive about their ability to access appointments at the practice.

The areas where the provider must make improvements are:

  • Introduce more comprehensive processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

  • The provider must ensure safe and effective management of medicines to include timely medication reviews and documentation of associated blood results, a system for recording prescriptions and improved security for storage of blank prescriptions.

  • Ensure that staff checking vaccine storage fridges are adequately trained and procedures in line with regulations for the safe management of vaccines.

  • The provider must ensure that appropriate and current patient information is shared on request with external agencies in particular in relation to safeguarding concerns.

  • The provider must ensure there is a system of formal and documented communication between GP and staff.

  • Ensure all patient identifiable information is stored securely and disposed of appropriately.

  • Put systems in place to ensure all staff have access to appropriate training and support.

  • Ensure that an appropriate risk assessment for lone working staff is completed in regards to whether a DBS check needs to be undertaken.

  • Ensure a thorough system of risk management is implemented. Risk assessments that indicate mitigating actions are required must be followed through. Gaps in the assessment of risk within the practice, such as a legionella risk assessment, must be addressed.

The areas where the provider should make improvement are:

  • All policies should be included on the newly devised policy inventory in order to be sure that all practice policy documents are reviewed appropriately when needed.
  • References requested as part of the recruitment process need to be clearly identified as to who has provided them and when.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17/06/2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

On 23 September 2015 we carried out a full comprehensive inspection of Rishton and Great Harwood Surgery which resulted in a Warning Notice being served against the provider. The Notice advised the provider that the practice was failing to meet the required standards relating to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe Care and Treatment.

On 17 June 2016 we carried out a focussed inspection of the Rishton site to check the provider had taken the required action in relation to the Warning Notice which we issued on 26 October 2015.

At this inspection we found that some progress had been made against the contents of the Warning Notice, but that some concerns also remained.

Specifically we found that:

  • Improvements had been made around the assessment and mitigation of risks to staff and patients.

  • Comprehensive health and safety and fire risk assessments were now in place, and appropriate mitigating actions taken as a result.

  • A medical emergency procedure was now in place and oxygen available on site.

  • An incoming mail protocol was now in place to ensure correspondence received into the practice was actioned appropriately and to mitigate the risk of this not being done when locum GPs covered in the absence of the GP partners.

  • An infection control audit had been carried out, although all actions identified had not been completed. Plans were in place to provide all staff with appropriate infection prevention and control training.

  • Gaps continued to be evident in the practice’s recruitment processes meaning that associated risks were not managed. For example, references were not consistently sought and new staff who acted as chaperones had not received Disclosure and Barring Service (DBS) checks.

A further full comprehensive inspection will be carried out at this location in the near future in order to rate this practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

23/09/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rishton and Great Harwood Surgery on 23rd September 2015. Overall the practice is rated as Inadequate.

Our key findings across all the areas we inspected were as follows:

  • Risks to patients were not assessed or managed appropriately. No risk assessments for areas such as fire safety, lone working or medical emergencies had been carried out.
  • Staff were unaware the building was equipped with a fire alarm system. Checks had not been carried out to ensure the alarm was working properly. There were insufficient systems in place to ensure people’s safety in the event of a fire.
  • No oxygen was available on site, meaning the practice was not fully equipped to respond to a range of medical emergencies which may occur.
  • Appropriate recruitment checks on staff were not consistently undertaken prior to their employment, for example references were not sought or interviews documented.
  • Staff received training, however access to training was not systematically managed. This led to gaps in training particularly around safeguarding and infection prevention and control. Staff had not received any infection control training and the GPs had not received the appropriate level of training around safeguarding children.
  • Staff were not fully aware of significant events that had recently been analysed, which suggested that learning from them was not shared or maximised.
  • Data showed patient outcomes were average when compared nationally. We saw that the practice engaged in clinical audit in an effort to improve the services delivered.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Urgent appointments were usually available on the day they were requested. The GP would offer further appointments beyond the end of his allotted surgery times in order to avoid turning patients away without seeing them.
  • There were a number of policies and procedures to govern activity, but these were not always comprehensive or relevant to services offered by the practice.
  • The practice had an active Patient Participation Group and proactively sought feedback from patients.

The areas where the provider must make improvements are:

  • Implement a more effective, systematic approach to identifying and managing risks within the practice.
  • Ensure there is a robust system to effectively manage incoming mail in the absence of the GP partners.
  • Ensure that the service provided is monitored and audited to ensure the safety, health and wellbeing of patients and staff.
  • Ensure fire safety procedures, for example nominating fire wardens and ensuring fire exits are accessible, are implemented.
  • Ensure that there is appropriate equipment to respond to a medical emergency and provide written guidance for staff on how to respond to such emergencies.
  • Ensure infection prevention and control audits are completed regularly and action plans developed as appropriate.
  • Implement a more systematic approach to recording and evidencing staff training. Staff must receive appropriate training in areas such as safeguarding and infection control.
  • Ensure recruitment arrangements include all necessary employment checks for all staff.
  • Ensure the policies and procedures that are available to staff are up to date and accurate.

In addition the provider should:

  • Utilise alerts on the electronic record system so that at risk or vulnerable patients are flagged up to clinicians in order to maximise their opportunity to receive the appropriate care.
  • Ensure a systematic approach is applied to monitoring and logging emergency drug and vaccine stocks held and their expiry dates.
  • Develop a business strategy to formalise the vision and direction for the practice in the short to medium term.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected within six months after the report is published. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice